Metabolic glucose status and pituitary pathology portend therapeutic outcomes in acromegaly.

Abstract

INTRODUCTION:

Acromegaly is frequently associated with impaired glucose tolerance and/or diabetes. To evaluate the relationship between glucose metabolism and acromegaly disease, we evaluated 269 consecutive patients from two referral centres.

METHODS:

Clinical presentation, pituitary tumor size and invasiveness, and pituitary pathology were captured in a dedicated database.

RESULTS:

131 women and 138 men with a mean age of 53.8 years were included. Of these, 201 (74.7%) presented with a macroadenoma and 18 (6.7%) with a microadenoma. Radiographic invasion was present in 91 cases (33.8%). Mean tumor diameter was 1.86 cm (0.2-4.6). Pituitary histopathologic findings revealed pure GH-producing somatotroph adenomas (SA) in 147 patients, prolactin-production by mixed lactotroph (LA) and SA or mammosomatotroph adenoma (MSA) in 46 [22.4%], acidophil stem cell adenoma in 6 [2.9%], and other diagnoses in 6 [2.9%]. Medical treatment included octreotide in 96 [36.9%] and in combination with pegvisomant or dopamine agonists in 63 [24.2%]. Nearly 80% of patients achieved IGF-1 normalization. Importantly, patients with pure somatotroph adenomas were significantly more likely to present with abnormal glucose metabolism [48.7%] than those with mixed adenomas [9.7%] [p<0.001] independent of GH/IGF-1 levels or tumor invasiveness. Abnormal glucose metabolism and pituitary pathology also remained linked following IGF-1 normalization. Moreover patients with pure SA and abnormal glucose metabolism were significantly (p<0.001) less likely to achieve disease remission despite the same therapeutic strategies. Conversely, patients with mixed adenomas were more likely (OR: 2.766 (95% CI: 1.490-5.136) to achieve disease remission.

CONCLUSIONS:

Patients with pure somatotroph adenomas are more likely than those with mixed adenomas to exhibit abnormal glucose metabolism.

• Authors: Sonia Cheng, Rany Al-Agha, Paula B Araujo, Omar Serri, Sylvia L Asa, Shereen Ezzat
• Journal: PloS one (PLoS One) Vol. 8 Issue 9 Pg. e73543 ( 2013) ISSN: 1932-6203 [Electronic] United States
• PMID: 24039977 (Publication Type: Journal Article)

Chemical References

• Human Growth Hormone
• Insulin-Like Growth Factor I
• Growth Hormone
• Glucose
• pegvisomant

Topics

• Acromegaly (complications, metabolism, pathology, therapy)
• Adenoma (complications, metabolism, pathology, therapy)
• Female
• Glucose (metabolism)
• Growth Hormone (metabolism)
• Growth Hormone-Secreting Pituitary Adenoma (complications, metabolism, pathology, therapy)
• Human Growth Hormone (analogs & derivatives, metabolism)
• Humans
• Insulin-Like Growth Factor I (metabolism)
• Male
• Middle Aged
• Pituitary Gland (metabolism, pathology)
• Pituitary Neoplasms (complications, metabolism, pathology, therapy)